0 Labor Management Partnership: Kaiser Permanente’s strategy for frontline engagement and performance July 2012

Our Labor Management Partnership Largest and most comprehensive labor-management partnership in the country 29 local unions representing more than 95,000 KP workers (including nurses, technicians, clerical and service employees) The partnership reflects our business strategy to: Improve organizational performance Deliver high quality care and service to our members Involve the union and individual workers in decisions that affect the workplace Make Kaiser Permanente the best place to get care and best place to work

Core principles of partnership since 1997 “Health care services and the institutions that provide them are undergoing rapid change... Now is the time to enter into a new way of doing business…to unite around our common purposes and work together to most effectively deliver high quality health care and prevail in our new, highly competitive environment.” - National Partnership Agreement, 1997

Unit-based team: A natural work group of frontline workers, physicians and managers who solve problems and enhance quality for tangible results. UBTs work together to: Set goals Review and evaluate performance Identify and solve problems Contribute to decisions on budget, staffing and scheduling What’s a unit-based team?

KP Value Compass

UBT Path to Performance Level 1Level 2Level 3Level 4Level 5 Pre-Team Climate FoundationalTransitionalOperationalHigh-Performing Learning what a UBT is and how it works. Establishing structures and norms. Demonstrating progress. Joint leadership, improved performance. Full collaboration and measurable success. Roadmap for team development

High-performance criteria Dimension Level 5 High-Performing UBT* Sponsorship + Sponsors holding teams accountable for performance. Leadership + Co-leads jointly accountable. Training + Advanced performance improvement training. Team Process + Most day-to-day decisions made by team members. Team Member Engagement + Team members connect unit performance to broader strategic goals of Kaiser Permanente. Use of Tools + Using advanced performance improvement training. Goals and Performance + Team is achieving targets and sustaining performance on multiple measures. * Selected examples of Level 5 performance metrics

Growth of high-performing teams 7 1,167 teams were rated high-performing as of June 2012

Rapid Improvement Model: Plan, Do, Study, Act

FEATURED TEAM: Ambulatory Surgery Recovery, Moanalua Medical Center, Honolulu Cutting costs, clutter in the OR Read more about the teams work and other successful practices on the Labor Management website, Labor co-lead: Avis Yasumura, RN, Hawaii Nurses Association, OPEIU Local 50 Management co-lead: Janet Lundberg, RN, procedural sedation manager RESULTS: The team saved nearly $10,000 per month by reducing duplicate and overstocked supplies for medical center’s operating room. WHAT THEY ARE DOING: Team members created a more organized supply room by clearly labeling shelves and supplies, helping them keep better track of their inventory. They are also maintaining the inventory on a computer.

FEATURED TEAM: Labor and Delivery, Moanalua Medical Center, Honolulu Nurses help newborns get closer to moms RESULTS The percentage of newborn babies spending at least 60 minutes with their mothers in skin-to-skin contact right after birth: WHAT THEY DID Read more about the teams work and other successful practices on the Labor Management website, The team created a baseline measure by tabulating instances of skin-to-skin contact for each patient in a spreadsheet, using KP HealthConnect data. Members of the representative UBT did one-on-one education with fellow nurses and other staff members The team communicated in different ways, including informal conversations, bulletin board posters and handouts.

FEATURED TEAM: Inpatient Pediatrics, South Bay Medical Center Cute Kids Inspire Clean Hands RESULTS Percent of staff members observed by peers to follow good hand-hygiene practices: WHAT THEY DO To boost low scores on hand-washing observation surveys, staff members: Tabulated peer observations of hand-hygiene practices Hung posters outside patient rooms featuring photos of cute kids, reminding staff members and visitors to wash their hands or clean them with sanitizing gel. Mounted sanitizer dispensers outside and inside patient rooms. Began a practice of talking to patients while cleaning hands to raise their awareness of the issue.

UBTs advance patient safety 2 North-South Medical-Surgical units, San Diego: Improving patient safety WHAT THEY DID: Patient-turning checklist: Key things that should be done when turning a patient, such as ensuring a patient’s bed rails have been lowered. Regular safety observations, staff safety training and observations of teams turning patients; peer feedback on handling techniques. Set goals and celebrate small goals RESULTS: 389 days without a patient- handling injury as of early 2011

Leveraging Partnership to Grow KP Enhancing the New Member Experience to Boost Retention The Mid-Atlantic States recently recruited 3,200 new members through joint union- management efforts. Knowing the importance of the new member experience to member satisfaction and retention, the Falls Church UBT (which previously had lagged the region in service scores) developed bilingual informational kits and facility tours. This contributed to a 12-point increase in Falls Church service scores in 2011, exceeding the service area's goal. Colorado has rolled out its "Love at First Visit" training to all clinical staff. The training has helped boost first-visit satisfaction scores in the region. For example, the Hidden Lake Medical Office improved its scores by 20 percent from December 2010 to August UBTs elsewhere are developing effective ways to get new members more information – especially cost-sharing members who often need help understanding how their plan works.

Building a learning culture “Performance is increasingly determined by factors that can't be overseen: intelligent experimentation, ingenuity, interpersonal skills, resilience in the face of adversity.... People rely on their own and their colleagues’ judgment and expertise, rather than on management direction, to decide what to do.” Amy C. Edmondson, The Competitive Imperative of Learning Harvard Business School